Provider Demographics
NPI:1699193334
Name:GARDEN, BENJAMIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:C
Last Name:GARDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1209
Mailing Address - Country:US
Mailing Address - Phone:847-679-5199
Mailing Address - Fax:847-679-5490
Practice Address - Street 1:4605 GOLF RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-679-5199
Practice Address - Fax:847-679-5490
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145621207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery